As the opioid dependency epidemic continues to ravage the United States, the types of substances used by Americans to further the habit continue to evolve. Heroin that was popular in decades past gave way to prescription opioids in the new millenium, and is now experiencing resurgence. Further, many Americans are now turning to a substance that is new to the West, kratom, for its opioid-like properties.
Kratom (Mitragyna speciosa) is a tree in the same plant family as coffee that is indigenous to parts of Southeast Asia. Its leaves have been used as traditional medicine there because of its stimulant like properties in low doses, and opioid like effects at high doses. In recent years, more people have been using kratom to try and control chronic pain, opioid withdrawal symptoms, or to use it recreationally to get high. Side effects of the substance include nausea, vomiting, constipation, seizure and even death when combined with other substances. Some people trying to wean themselves off other opioids find themselves inadvertently addicted to kratom!
Unintended addictions and kratom related deaths have contributed to a rising concern about more widespread use in the United States. From 2014 to 2016 there were 15 kratom related deaths in this country. In 2016 the DEA announced intent to classify kratom as a Schedule I controlled substance but later withdrew these initial plans pending further discussion. Nevertheless, kratom is currently illegal in Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin and has been considered for ban in other states like Florida because of its dangers.
Even though very little research has been done about kratom addiction, what would treatment for it look like? The withdrawal symptoms experienced when stopping kratom can be very similar to withdrawal from other opioids, albeit in a milder form. Thus short term medications to control nausea, diarrhea, body aches, chills and sweats would probably be appropriate. When abstinence is achieved, a medication with no opioid activity but other properties that would serve to control cravings and prevent relapse like naltrexone may be helpful.